Comment by dcolkitt | Hacker News Reader

Comment by dcolkitt | Hacker News Reader

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There's no evidence that population-wide skin cancer screening has any impact on overall mortality. And in fact dermatologists have an enormously high rate of misdiagnoses leading to a lot of unnecessary painful and stressful biopsies.

> The second ecological study compared the melanoma mortality experience in Germany with the melanoma mortality experience of subregions of 22 European countries for the years 2000 to 2013, none of which had organized screening programs. After adjustment for potential confounders, Germany and the 22 European regions had similar malignant mortality rates, suggesting no benefit of screening.[30]... One case of melanoma was detected per 28 excisions overall (for both men and women), while 52 skin excisions were required to detect one melanoma in men aged 20 to 34 years.[31]

https://www.cancer.gov/types/skin/hp/skin-screening-pdq#_24_...

My advice would be just the opposite. Unless you're an at-risk individual or have a family history of melanoma, skip the dermatologist appointment.

Very valid points, but for what it's worth some people will worry until they've got a negative from someone who knows what they're doing. False positives are stressful, but I like having someone who actually understands dermatology take a look, especially since I grew up getting way too much sun, and since I started balding have had a couple bad head burns (I now understand why hats are a good thing).

Also, if you don't have a partner who sees you naked on a regular basis, there are parts of your body you probably don't see too often. I have a birth mark my wife sees more than I do.

> Visual examination of the skin in asymptomatic individuals may lead to cosmetic or functional complications of diagnostic or treatment interventions and the psychological effects of being labeled with a potentially fatal disease, although robust data on the frequency of such events are lacking. Other harmful consequences are overdiagnosis, leading to the detection of biologically benign disease that would otherwise go undetected,[7,8,32] and the possibility of misdiagnosis of a benign lesion as malignant.

The potential harm does not sound too horrible, especially since anomaly detection normally results in removal of a small piece of your skin that heals easily and that's it.

> One case of melanoma was detected per 28 excisions overall (for both men and women), while 52 skin excisions were required to detect one melanoma in men aged 20 to 34 years.

On the other hand, the detection rate is actually quite high in my opinion, since they tend to cut out anything small that is suspicious and only do a thorough check afterwards.

It might be different from an economic point of view for the system paying for these checks, but as an individual I'd say there is little to lose and a lot to gain. (The options usually are: Nope, no cancer and you have a small wound/scar. / Yes, it was cancer, but we already took it out so you're fine now.)

Melanoma biopsies are not typically “small pieces of skin”.

Any other kind of biopsy will be unreliable and is more likely to be a waste.

How are you basing detection rate on that information? Hint: you can’t. Or if you are implying that detecting 1 case in 52 cases of melanoma is good (a sensitivity of 2%) then you’re nuts.

All medical students and dermatologists train on the basic guidelines for skin cancer screening. Please leave this to the professionals.

If you notice a something weird on your skin, you should definitely see a doctor. Otherwise, there's absolutely no benefit to routine dermatology check-ups; this sort of futile over-investigation and over-treatment is one of the major reasons why healthcare in the US is so cripplingly expensive.

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